Integral photoradiation therapy of multifocal bladder tumors

Focal and diffuse hematoporphyrin derivative (HpD) photodynamic therapy was used for the treatment of resistant transitional cell carcinoma in situ (Tis) in 30 patients. Patients were given HpD intravenously followed by either focal light irradiation (630 nm) or diffuse bladder irradiation via a light bulb fiber. The light source was an argon ion pumped dye laser circulating rhodamine B dye. All patients were followed with periodic cystoscopic examinations, bladder biopsies, and urine cytologic examinations. All of the 15 patients who underwent focal therapy had biopsy and cytologic evidence of disappearance of the lesion in the treated area at the 3-month follow-up cystoscopic examination. Eight patients have experienced one or more recurrent lesions either in the treated area or in distant areas, and in each the recurrence was successfully treated with HpD photodynamic therapy. Eight of the 11 patients with diffuse Tis have returned for their 3-month follow-up evaluation, and all demonstrated disappearance of tumor (3 of these 8 patients have subsequently developed focal recurrent Tis). Four patients had diffuse Tis plus Ta lesions (2 patients) or T2 lesions (2 patients), and all had disappearance of the Tis, but persistence of the Ta or T2 disease. We conclude that HpD photodynamic therapy appears effective in the treatment of resistant Tis.